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Relationship between Doppler ultrasound parameters of uterine artery, umbilical artery, middle cerebral artery and placental vasculopathology and pregnancy outcome in preeclampsia rat model
MA Ruilin, LIU Yu, XU Guixiang, SHI Haoran, CUI Jianjian, YANG Zejun, MAO Yan, ZHAO Yin
2024, 44 (5):  543-551. 
doi: 10.3969/j.issn.1674-8115.2024.05.001

Abstract ( 40 )   HTML ( 9 )   PDF (4725KB) ( 28 )  

Objective ·To measure the parameters of the uterine artery, umbilical artery and middle cerebral artery in a rat model of preeclampsia (PE) by Doppler ultrasound, and compare the pathological changes in placental blood vessels and pregnancy outcomes, in order to provide an effective method and reference for evaluating placental function in PE animal models. Methods ·PE (n=8) and normal pregnancy (NP, n=8) groups in Sprague-Dawley (SD) rat models were established by intraperitoneal injections of N′-nitro-L-arginine methylesterhydrochloride (L-NAME) and 0.9% sodium chloride solution. Blood pressure and proteinuria indexes were detected to evaluate whether the model was successfully established. On gestational day 19 (GD19), Doppler ultrasound was utilized to measure the parameters of the uterine artery, umbilical artery and the fetal middle cerebral artery in both the PE and NP groups. After termination of the pregnancies, placental function was evaluated through the pathology of placental blood vessels and the quality of the fetuses and placentas. Results ·In the PE group, both blood pressure (GD15: P=0.001; GD19: P=0.001) and proteinuria (GD15: P=0.001; GD19: P=0.001) were significantly higher than those in the NP group. The pulsatility index (PI) of the umbilical artery and uterine artery was notably elevated in the PE group compared to the NP group (both P=0.000). Furthermore, the resistance index (RI) of the fetal middle cerebral artery was significantly lower than that in the PE group (P=0.000). While the number of fetal rats did not differ significantly, the quality of placental and fetal rats was notably lower in the PE group (P=0.006 and P=0.000, respectively). Immunohistochemical staining of placental tissue revealed that the number of placental micro vessel densities in the PE group was less than that in the NP group (P=0.001). Correlation analysis revealed that placental micro vessel density, fetal quality and placental quality were inversely related with the RI of the umbilical artery and the PI and RI of the uterine artery, and positively correlated with the S/D, PI and RI of the fetal middle cerebral artery (all P<0.05). Conculsion·Doppler ultrasound assessment of the uterine artery, umbilical artery and middle cerebral artery indices in L-NAME-induced PE rat models effectively reflects pregnancy outcomes and placental vascular pathology. This method is valuable for evaluating placental vascular perfusion in PE rat models, offering practicality and convenience for research involving animal models.

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Feasibility study on quantifying retinal vascular features for predicting preeclampsia based on artificial intelligence models
ZHOU Tianfan, SHAO Feixue, WAN Sheng, ZHOU Chenchen, ZHOU Sijin, HUA Xiaolin
2024, 44 (5):  552-559. 
doi: 10.3969/j.issn.1674-8115.2024.05.002

Abstract ( 31 )   HTML ( 7 )   PDF (2497KB) ( 25 )  

Objective ·To explore the predictive capability of retinal vascular features in preeclampsia (PE) based on artificial intelligence (AI) models. Methods ·This retrospective study enrolled 789 pregnant women who registered from June 2020 to January 2021 at Shanghai First Maternity and Infant Hospital of Tongji University in the first 16 weeks of gestation. These women underwent regular prenatal examinations, had retinal fundus images captured, and delivered singleton live births at the hospital. According to whether they developed hypertensive disorders of pregnancy (HDP), they were divided into unaffected group (n=685) and HDP group (n=104). Within the HDP group, pregnancies were further categorized into gestational hypertension (GH) group (n=36) and PE group (n=68) based on the occurrence of PE. Based on the gestational age at onset, the PE group was further divided into early-onset PE group (gestational age<34 weeks) and late-onset PE group (gestational age≥34 weeks). Fundus images of the pregnant women were obtained, and an AI algorithm was utilized to diagnose retinal lesions and quantify retinal vascular features. Comparative analyses were conducted on fundus features and retinal vascular features. Univariate Logistic regression model was employed to analyze the influencing factors of PE occurrence, and multivariate Logistic regression model was further utilized to assess the correlation between retinal vascular features and the occurrence of PE. The predictive capability of retinal vascular features for PE (both early- and late-onset PE) was analyzed by using area under the curve (AUC) of receiver operator characteristic curve (ROC curve). Results ·The comparative analysis of fundus features and retinal vascular features demonstrated statistically significant differences between the unaffected group and PE group in terms of central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), arteriole-to-venular ratio (AVR), retinal artery tortuosity and retinal artery fractal dimension (all P<0.05). Univariate Logistic regression analysis indicated that second-trimester mean arterial pressure (MAP), second-trimester estimated fetal weight (EFW), CRAE, CRVE, AVR, retinal artery tortuosity and retinal artery fractal dimension were the influencing factors for PE occurrence (all P<0.05). Multivariate Logistic regression analysis revealed that second-trimester EFW, CRAE, CRVE, AVR, retinal artery tortuosity and retinal artery fractal dimension were the protective factors for the occurrence of PE, while second-trimester MAP was the risk factor for PE (all P<0.05). The analysis of ROC curves revealed that maternal risk factors along with second-trimester prenatal examination data (including MAP and EFW) and retinal vascular features model had good predictive ability for PE [AUC (95% CI)=0.784 (0.725-0.843), and this model exhibited better predictive capability for early-onset PE, with an AUC (95% CI) of 0.840 (0.756-0.924). Conclusion ·The integration of quantified retinal vascular features based on AI models with maternal risk factors and second-trimester prenatal examination data (including MAP and EFW) enables a more effective prediction of PE occurrence, particularly early-onset PE.

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Analysis of risk factors of adverse pregnancy outcomes in patients with chronic kidney disease
LI Yu, ZHANG Yu
2024, 44 (5):  560-566. 
doi: 10.3969/j.issn.1674-8115.2024.05.003

Abstract ( 35 )   HTML ( 5 )   PDF (1545KB) ( 22 )  

Objective ·To find out the risk factors leading to adverse pregnancy outcome by analyzing the correlation of clinical data and adverse pregnancy outcomes in patients with pregnancy complicated with chronic kidney disease. Methods ·The clinical data before 20 weeks of gestation of single pregnant patients discharged with a diagnosis of chronic kidney disease who conducted standardized prenatal examination and delivered in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021 were collected retrospectively. According to the pregnancy outcomes, patients were divided into adverse pregnancy outcome group (study group) and good pregnancy outcome group (control group). The clinical data, laboratory test results and pregnancy outcomes of the two groups of pregnant women were compared, and the risk factors leading to adverse pregnancy outcomes were analyzed. Results ·Maternal clinical data of 359 pregnant patients were collected, 6 cases of twin pregnancy were excluded, and the remaining 353 cases of pregnancy with chronic kidney disease were included in this study. Among them, 230 cases of pregnancy without related maternal and fetal complications were included in the good pregnancy outcome group (control group), and 123 cases of pregnancy with adverse maternal and fetal outcomes were included in the adverse pregnancy outcome group (study group). The adverse pregnancy outcome group (one pregnancy can have multiple adverse pregnancy outcomes) includes 69 cases of preeclampsia (including 43 cases of severe preeclampsia), 29 cases of acute kidney injury, 69 cases of premature delivery, 34 cases of infants smaller than gestational age, 46 cases of low birth weight infants, 41 cases of neonatal admission to NICU, and 7 cases of miscarriage after 20 weeks of gestation or neonatal death. There were no differences in age, body mass index, pregnancy times and birth times between the study group and control group. In patients with chronic kidney disease, those who had chronic hypertension (OR=3.385, 95% CI 1.115—10.726, P=0.031), serum creatinine over 60 μmol/L (OR=2.828, 95% CI 1.439—5.557, P=0.003), 24-hour urine protein≥0.3 g (OR=2.234, 95% CI 1.122—4.448, P=0.022), and lupus nephritis before 20 weeks of gestation (OR=4.917, 95% CI=1.967—12.290, P=0.001) were at significantly higher risk of adverse pregnancy outcomes. The area under the ROC curve was 0.759, the sensitivity was 52.8%, and the specificity was 84.2% for predicting adverse pregnancy outcomes in pregnant women with chronic kidney disease. Conclusion ·Chronic hypertension, 24-hour urine protein≥0.3 g, nephritis type of lupus nephritis and serum creatinine≥ 60 μmol/L before 20 weeks of gestation are independent risk factors for adverse pregnancy outcome in CKD patients. The combination of the above four indicators have a good predictive value for adverse pregnancy outcomes.

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Basic research
Establishment and evaluation of various in vitro screening systems for peptide inhibitors targeting SAE1 and SAE2 interaction
HU Chenyang, LU Shaoyong, YANG Xiuyan
2024, 44 (5):  567-575. 
doi: 10.3969/j.issn.1674-8115.2024.05.004

Abstract ( 45 )   HTML ( 8 )   PDF (2608KB) ( 27 )  

Objective ·To establish various in vitro screening systems for the discovery of peptide inhibitors targeting the interaction between small ubiquitin-like modifier (SUMO)-activating enzyme subunit 1 (SAE1) and subunit 2 (SAE2), as well as to evaluate their advantages, disadvantages, and applicability to this research. Methods ·The DNA fragments encoding human SAE1 and SAE2 were cloned into vector pET-28a, respectively, to generate protein SAE1 and SAE2. Purified proteins were used to establish screening assays, including isothermal calorimetry (ITC), fluorescence polarization (FP), surface plasmon resonance (SPR) and a fluorescence assay based on the SAE enzyme activity. The inhibitory activity of peptide candidates in different screening systems was examined, and their performance in terms of sensitivity, robustness, throughput and cost was evaluated. Results ·The dissociation constant (Kd) of in vitro SAE1 and SAE2 interaction was determined to be 0.96 μmol/L by ITC, and PEPT7 was identified as the most potent peptide. However, the tracer of FP, which was derived from PEPT7, was not up to snuff due to its low affinity with SAE2. In the SPR assay, the Kd value (=1.13 μmol/L) of SAE1 and SAE2 interaction was in line with the results from ITC. The SAE enzyme activity-based screening assay revealed that HP1B, the most effective peptide, inhibited SAE with an half-maximal inhibitory concentration (IC50) of 15.72 μmol/L. The affinity of HP1B for SAE1 was determined to be 34.4 μmol/L by SPR. Conclusion ·Several common screening systems for protein-protein interation (PPI) inhibitors are established and compared. Among them, ITC does not allow for high-throughput screening and it is difficult to accurately evaluate the low-affinity polypeptides with insignificant binding heat. The feasibility of FP relies heavily on the strong affinity between a tracer peptide and the protein target, making it unsuitable for the screening and optimization of low-affinity peptides. SPR is highly sensitive but the cost is high. The SAE enzyme activity-based assay stands out because it is a combination of high sensitivity, robustness, throughput and acceptable cost.

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Relationship between polymorphic interaction of glutamate pathway genes and anhedonia
HUANG Xinxin, LIU Chao, LÜ Qinyu, HU Guoqin, BAO Chenxi, ZHANG Yao, YI Zhenghui
2024, 44 (5):  576-583. 
doi: 10.3969/j.issn.1674-8115.2024.05.005

Abstract ( 35 )   HTML ( 5 )   PDF (2084KB) ( 22 )  

Objective ·To explore the association between gene-gene interaction of glutamate pathway and anhedonia. Methods ·A total of 279 patients with schizophrenia (SZ) and 236 patients with major depression disorder (MDD) recruited in the outpatient department and ward of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, and 236 healthy controls (HC) recruited in the community from January 2017 to August 2020 were included in the study. General demographic data and clinical characteristics of the three groups were collected and compared. The Chinese version of Temporal Experience of Pleasure Scale (TEPS) was used to evaluate the pleasure experience ability of the three groups. Generalized multifactor dimensionality reduction (GMDR) method was used to establish the interaction model of the single nucleotide polymorphism (SNP) in glutamate pathway genes (NOS1AP, GSK3β, DAOA, DISC1 and GRIN2A). According to the interaction model, SZ and MDD patients were divided into high-risk group and low-risk group, and the differences in pleasure experience ability were compared between the two groups, so as to analyze the effect of gene-gene interaction on anhedonia. Results ·There were significant differences in age and years of education among the three groups, and in age of onset and duration of illness between SZ and MDD groups (all P=0.000). There were significant differences among the three groups of participants in terms of overall pleasure experience, anticipatory pleasure experience and consummatory pleasure experience (all P=0.000); the overall pleasure experience, anticipatory pleasure experience and consummatory pleasure experience in the SZ and MDD group were lower than those in the HC group (all Pcorr =0.000), and there was marginal statistical difference in anticipatory pleasure experience between the SZ and MDD groups (Pcorr=0.051). Through GMDR modeling, it was found that the 2-loci interaction model composed of DAOA-rs3916965 and DISC1-rs821577 had a predictive effect on the overall pleasure experience ability of SZ patients (P=0.003), and the 2-loci interaction model composed of NOS1AP-rs1858232 and GRIN2A-rs1014531 had a predictive effect on the anticipatory pleasure experience ability of MDD patients (P=0.037); moreover, the overall pleasure experience ability of patients in the SZ high-risk group and anticipatory pleasure experience ability of patients in MDD high-risk groups were lower than those in their low-risk groups (t=3.443, P=0.000; t=3.471, P=0.001). Conclusion ·The interaction of glutamate pathway gene polymorphisms may be involved in the occurrence of anhedonia.

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Clinical research
Impact of anxiety levels and alexithymia degree on the quality of life in patients with anxiety disorders
SU Shanshan, JIANG Wenhui, WANG Shuting, XU Mizhen, REN Xueqing, QIU Jianyin
2024, 44 (5):  584-590. 
doi: 10.3969/j.issn.1674-8115.2024.05.006

Abstract ( 37 )   HTML ( 8 )   PDF (1405KB) ( 19 )  

Objective ·To evaluate the relationship between anxiety level, alexithymia degree and quality of life in patients with anxiety disorders. Methods ·Anxiety disorder patients admitted to the outpatient department of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from October 1, 2020 to March 31, 2023 were selected as the research subjects, and 438 patients were ultimately included after exclusion. Among them, there were 271 patients with generalized anxiety disorder, 101 patients with panic disorder, 48 patients with social anxiety disorder, 12 patients with agoraphobia, and 6 patients with specific phobia. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), the twenty-item Toronto Alexithymia Scale (TAS-20) and World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) were used to assess the patients' anxiety level, depression level, alexithymia degree and quality of life, respectively, and the scale scores of patients with different subtypes of anxiety disorders were evaluated. Spearman correlation coefficient was used to analyze the correlation between anxiety level, depression level, alexithymia degree and quality of life in patients with anxiety disorders. Stepwise regression model was used to analyze the key variables affecting the quality of life in patients with anxiety disorders. Results ·There were no significant differences in HAMA score, HAMD-17 score and TAS-20 score among patients with different subtypes of anxiety disorders, but the differences in WHOQOL-BRIEF score were statistically significant (H=10.076, P=0.039). The results of Spearman correlation analysis showed that the WHOQOL-BRIEF score of anxiety disorder patients was negatively correlated with HAMA score, HAMD-17 score and TAS-20 score (r=-0.256, P=0.000; r=-0.311, P=0.000; r=-0.342, P=0.000). The results of stepwise regression analysis showed that age, HAMA score, HAMD-17 score and TAS-20 score had significant impact on the quality of life of patients (all P<0.05). Conclusion ·The quality of life in patients with different subtypes of anxiety disorders is different. The anxiety level, depression level and alexithymia degree are the key variables affecting their quality of life.

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Association between urinary excretion of protein-bound uremic toxins and upper urinary tract calculus
WANG Wenji, ZHONG Kaiyi, LI Jiaolun, ZHOU Yueling, HUANG Tao, DUAN Lizhu, SHEN Yuqi, LI Xuezhu, DING Feng, XIE Danshu
2024, 44 (5):  591-598. 
doi: 10.3969/j.issn.1674-8115.2024.05.007

Abstract ( 30 )   HTML ( 5 )   PDF (1680KB) ( 24 )  

Objective ·To investigate the relation between urinary excretion of protein-bound uremic toxins (PBUTs) and upper urinary tract calculus. Methods ·Residents aged 18?80 years in the community of Haitou, Danzhou city in Hainan Province were recruited. Basic information and diet for the last 3 d of the subjects were recorded. Their fasting sera and 24-hour urine samples were collected, and they also underwent ultrasound examination of kidneys and ureters. The subjects with upper urinary calculi detected by ultrasound or a clear history of upper urinary calculi were selected as the calculus group, and the others as the non-calculus group. The biochemical indicators related to the formation of calculus in blood and urine were detected, and the levels of PBUTs, including indoxyl sufate (IS), indole-3-acetic acid (IAA), and p-cresol sulfate (PCS) in blood and urine, as well as oxalic acid and citric acid in urine were detected by high-performance liquid chromatography. The related factors of upper urinary tract calculus formation were analyzed by multivariate Logistic regression. The correlations of urine PBUTs with urine uric acid, oxalic acid, and citric acid were analyzed by Spearman correlation test. Results ·A total of 117 participants were screened out with 54 people in the calculus group and 63 people in the non-calculus group. There were no significant differences between the two groups in terms of gender, age, serum indicators, and prevalence of complications such as hypertension, diabetes, and hyperuricemia/gout. The 24-hour urine pH, calcium, uric acid, and chlorine in the calculus group were significantly higher than those in the non-calculus group (all P<0.05), while IS was significantly lower than that in the non-calculus group (P<0.05). Multivariate Logistic regression analysis showed that urinary IS (OR=0.929, 95%CI 0.875?0.986, P=0.016) was related to the calculus formation independently, in addition to urinary calcium. The Spearman correlation analysis results showed that the levels of IAA (r=0.420, P=0.000) and PCS (r=0.307, P=0.001) in 24-hour urine were positively correlated with oxalic acid, PCS was positively correlated with uric acid (r=0.297, P=0.002), and IS was positively correlated with citric acid (r=0.289, P=0.002). Conclusion ·In the population, a decrease in urinary excretion of IS may be an independent risk factor for the formation of upper urinary tract calculus, and PBUTs levels are correlated with levels of uric acid, oxalic acid, and citric acid.

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Predictive value of Clinical Frailty Scale in long term prognosis of patients with acute myocardial infarction after in-hospital cardiac rehabilitation
LIU Yuting, YU Wanqi, HONG Wen, KANG Sang, LI Xinni, DANZENG Quyang, XIAO Huoyuan, PAN Jingwei
2024, 44 (5):  599-605. 
doi: 10.3969/j.issn.1674-8115.2024.05.008

Abstract ( 29 )   HTML ( 6 )   PDF (1588KB) ( 38 )  

Objective ·To investigate the predictive value of the Clinical Frailty Scale (CFS) in the long term outcomes in acute myocardial infarction (AMI) patients who completed in-hospital cardiac rehabilitation (CR). Methods ·A total of 501 AMI patients treated in the Cardiology Center of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University of Medicine from May 2020 to May 2022 were prospectively enrolled, with their baseline clinical data collected. The patients completed graded in-hospital CR and were assessed by CFS based on their completion of CR before discharge. Patients were then categorized into three groups (norm group, vulnerable group and frail group) according to their CFS level. The difference in 1-year major cardiovascular event (all-cause death and re-hospitalization for heart failure) rates among the three groups was investigated. Logistic regression analysis was performed to explore the effective risk factors relevant to the outcomes, and receiver operator characteristic (ROC) curves were generated to analyze the prognostic value. Finally, an optimal prediction model was developed. Results ·The CFS level in AMI patients who completed CR was positively correlated with age and peak pro-B-type natriuretic peptide (peak proBNP), and inversely correlated with gender difference (P<0.05). Accompanied with the elevated CFS level, the incidence of both outcomes increased, and there were significant differences in all-cause death (2.6%,5.6% and15.2%, P=0.002), and while no significant differences in re-hospitalization for heart failure among the three groups (19.6%,22.2% and 24.2%). All-cause death of the frail group was significantly higher than that of the norm group (P=0.004), while there was no significant difference between the vulnerable group and the norm group. CFS could sensitively predict the 1-year all-cause death in AMI patients (β=1.89, OR=6.61, P=0.001), and the risk model combined with CFS had the best predictive effect (AUC=0.845, P=0.000). Conclusion ·Assessment by CFS in AMI patients who completed in-hospital CR contributes to identifying AMI patients with high risk of all-cause death in 1 year.

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Evidence-based medicine
Evaluation of circadian rhythms in depression by using actigraphy: a systematic review and meta-analysis
SUN Chenyin, WU Baichuan, ZHANG Huifeng, FANG Yiru, PENG Daihui
2024, 44 (5):  606-616. 
doi: 10.3969/j.issn.1674-8115.2024.05.009

Abstract ( 26 )   HTML ( 6 )   PDF (4047KB) ( 32 )  

Objective ·To systematically review the effectiveness of actigraphy on the evaluation of circadian rhythm characteristics in patients with depression. Methods ·A systematic literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, CNKI, WanFang Data, and Chinese biomedical literature database (CBM), from the inception of each database to May 5th, 2023. Case control studies that used actigraphy to evaluate circadian rhythms in patients with depression and compared them with healthy controls were collected. Literature was screened according to the inclusion and exclusion criteria, and the quality of the included literature was evaluated by using the Newcastle-Ottawa Scale. The meta-analysis was performed by using RevMan 5.4 software. Results ·A total of 9 articles were included, including 390 patients with depression and 288 healthy controls. The meta-analysis showed that the MESOR (midline statistic of rhythm) (SMD=-0.29, 95% CI -0.51 ? -0.07, P=0.009) of the circadian cosine function in patients with depression was lower than that in healthy controls; sleep onset (MD=33.06, 95% CI 14.90 ? 51.23, P=0.000) and sleep offset (MD=53.80, 95% CI 22.38 ? 85.23, P=0.000) were later in patients with depression than those in healthy controls; no statistical difference was found in the activity level of the most active 10 hours (SMD=-0.26, 95% CI -0.52 ? 0.01, P=0.060) between patients with depression and healthy controls, although there was a trend for lower activity in patients with depression; no statistical difference was found in the acrophase (MD=25.33, 95% CI -12.41 ? 63.06, P=0.190) of the circadian cosine function between patients with depression and healthy controls; no clear statistical significance of the difference was found in the amplitude (SMD=-0.14, 95% CI -0.42 ? 0.14, P=0.340) and the activity level of the least active 5 hours (SMD=0.31, 95% CI -0.10 ? 0.71, P=0.140) between patients with depression and healthy controls. Conclusion ·Actigraphy can reflect circadian rhythm disruption in patients with depression to some extent, but the limited number of included studies and inconsistencies in the study populations and methodologies have affected the quality and results of the analyses. More high-quality clinical trials are needed to provide evidence.

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Public health
Analysis of epidemiological characteristics of risk factors for cardiovascular diseases and malignant tumors based on the Shanghai community elderly cohort
LI Ping, JIANG Huiru, YE Mengyue, WANG Yayu, CHEN Xiaoyu, YUAN Ancai, XU Wenjie, DAI Huimin, CHEN Xi, YAN Xiaoxiang, TU Shengxian, ZHENG Yuanqi, ZHANG Wei, PU Jun
2024, 44 (5):  617-625. 
doi: 10.3969/j.issn.1674-8115.2024.05.010

Abstract ( 29 )   HTML ( 7 )   PDF (1480KB) ( 22 )  

Objective ·To analyze the epidemiological characteristics of risk factors for cardiovascular diseases and malignant tumors based on the Shanghai community elderly cohort. Methods ·The study subjects were selected from the Shanghai community elderly cohort established from February to August 2019, with a total of 17 948 people. The study subjects were divided into 4 groups according to self-reported presence or absence of tumors and/or cardiovascular diseases during the baseline survey: tumor-free and non-cardiovascular disease group, single cardiovascular disease group, single tumor group and tumor cardiovascular disease co-occurrence group. The differences among the four groups of subjects were collected and compared in terms of demographic characteristics and physiological indicators, daily living habits (smoking, drinking tea, drinking coffee, drinking carbonated drink, drinking alcohol, sedentary time, physical activity level and sleep quality), past medical history, psychological status (depression and anxiety) and dietary compliance. Results ·Among the study subjects, 60.1% of tumor patients were complicated with cardiovascular diseases. The differences among the four groups of subjects in age, gender, educational level, pre-retirement occupation, waist circumference, hip circumference and body mass index were statistically significant (all P<0.05). Compared with the tumor-free and non-cardiovascular disease group, the single cardiovascular disease group, single tumor group and tumor cardiovascular disease co-occurrence group all exhibited lower proportions of smoking and high physical activity levels (all P<0.05), and higher proportion of sedentary time exceeding 4 h/d and poor sleep quality (all P<0.05); the proportion of subjects with past medical histories including hyperlipidemia, peripheral vascular disease, endocrine system disease, respiratory system disease, urinary system disease and digestive system disease of the single cardiovascular disease group and the tumor cardiovascular disease co-occurrence group was higher (all P<0.05), and the proportion of subjects with depression and anxiety was also higher (all P<0.05). Furthermore, compared with the tumor-free and non-cardiovascular disease group, the single cardiovascular disease group had lower compliance rates of poultry, fish, fruit and liquid milk (all P<0.05). Among the four groups, only the compliance rate of vegetable intake exceeded 50%, while the compliance rates of poultry, fish, fruit, liquid milk and tubers were all below 20%. Conclusion ·In the elderly population of Shanghai communities, over half of malignant tumor patients are concomitant with cardiovascular diseases. Unhealthy daily habits are prevalent among those with cardiovascular diseases, tumors and tumor-cardiovascular disease co-occurrence. The intake of many foods in the elderly of the community do not reach the levels recommended by Chinese Dietary Guidelines.

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Review
Research progress in the central nervous system mechanism of dexmedetomidine
SONG Yifan, JIANG Linhao, YANG Qianzi, LUO Yan
2024, 44 (5):  626-634. 
doi: 10.3969/j.issn.1674-8115.2024.05.011

Abstract ( 51 )   HTML ( 13 )   PDF (1417KB) ( 33 )  

Dexmedetomidine, which is an α2 adrenergic receptor agonist with sedative, analgesic, anxiolytic and anti-sympathetic effects, has become a widely used drug in clinical anesthesia and intensive care unit (ICU). Compared with other drugs in the department of anesthesiology, dexmedetomidine has no obvious respiratory depression and no obvious hemodynamic changes, and can significantly reduce the dosage of sedative and analgesic drugs when combined with other anesthetics. In clinical applications, dexmedetomidine has been found to induce a sedative response that is associated with rapid arousal. Dexmedetomidine is traditionally thought to act through α2 adrenergic receptors to lower blood pressure, dilate blood vessels and lower heart rate, but it is unclear how it affects neural circuits in the brain. In recent years, there has been an increasing number of studies on the mechanism of action of dexmedetomidine, which has confirmed that the ventrolateral preoptic nucleus (VLPO), locus coeruleus (LC) and ventral tegmental area (VTA) of the hypothalamus are involved in the sedation mediated by dexmedetomidine, the dorsal root ganglion (DRG) and superior cervical ganglion (SCG) are involved in dexmedetomidine-mediated analgesia, and the hypothalamic preoptic area (PO) and hypothalamic paraventricular nucleus (PVN) are involved in the changes in body temperature and water-electrolyte balance mediated by dexmedetomidine, providing a new direction for understanding the mechanism of dexmedetomidine in the central nervous system.

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Progress in non-pharmacological interventions for weight gain in schizophrenia
CHEN Xiaochang, ZHANG Chen
2024, 44 (5):  635-640. 
doi: 10.3969/j.issn.1674-8115.2024.05.012

Abstract ( 24 )   HTML ( 8 )   PDF (1257KB) ( 44 )  

Schizophrenia is a chronic mental disorder that often co-occurs with weight gain issues, which impacts medication adherence and symptom recovery in patients, and increases the risk of metabolic and cardiovascular diseases. However, the specific mechanism of weight gain in the patients with schizophrenia remains incompletely understood. Potential factors include increased appetite and abnormal glucose and lipid metabolism due to the effects of antipsychotic drugs on multiple neurotransmitter receptors, shared pathogenesis between schizophrenia and obesity, and unhealthy dietary preferences and lifestyles among the patients with schizophrenia. In recent years, the progress in non-pharmacological interventions in the treatment of weight gain in schizophrenia has been continuously updated, which mainly includes lifestyle interventions, bariatric surgery and neuromodulation technology. Lifestyle interventions include diet, exercises and cognition, and the effectiveness of comprehensive lifestyle intervention models and compliance of patients have become the mainstream of research. Bariatric surgery has a weight loss effect on obese patients with schizophrenia who meet the surgical indications, but the total number of reported cases is still small, and further exploration of perioperative symptom management is needed. In neuromodulation technologies, repeated transcranial magnetic stimulation (rTMS) appears to be promising in the treatment of weight gain in the patients with schizophrenia. The aim of this article is to provide more diversified clinical strategies for the treatment of weight gain in schizophrenia.

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Role and research progress of transient receptor potential vanilloid-1 in acute respiratory distress syndrome
XI Hong, SHEN Jie, YANG Qianzi, DU Hailei, LUO Yan
2024, 44 (5):  641-646. 
doi: 10.3969/j.issn.1674-8115.2024.05.013

Abstract ( 20 )   HTML ( 6 )   PDF (1262KB) ( 19 )  

Acute respiratory distress syndrome (ARDS) is a severe critical respiratory disease characterized by refractory hypoxemia, which is caused by intrapulmonary and extrapulmonary factors. It has a rapid onset, and high morbidity and mortality. With the global prevalence and mutation of respiratory viruses, the diagnosis and treatment of ARDS have become more complicated, requiring exploration into the molecular mechanisms and effective therapeutic methods of the occurrence and development of ARDS in clinical practice. Researchers have found that the pathogenesis of ARDS involves the interaction of multiple factors, including imbalances in inflammatory responses and redox reactions, dysregulation of endothelial cells, disruption of alveolar-capillary barrier and abnormalities in coagulation function. Although advancements in molecular biology techniques such as genomics and proteomics have provided new insights into the pathogenesis of ARDS, there is still a lack of early diagnostic biomarker and effective drugs targeted for ARDS. At present, more comprehensive and in-depth basic and clinical research is still needed. Increasing evidence suggests that transient receptor potential vanilloid-1 (TRPV1), also known as the capsaicin receptor, plays a crucial role in respiratory system diseases. TRPV1 is widely distributed in the upper respiratory tract, airway smooth muscle, alveoli and pulmonary blood vessels, participating in mediating airway dilation and constriction, cough reflex, and release of inflammatory mediators related to inflammation and pain, as well as sensing and transmitting various biological signals related to temperature, chemical substances and mechanical stress stimuli in the respiratory system. The widespread distribution and diverse physiological functions of TRPV1 make it a research hotspot in the occurrence and development of respiratory system diseases such as pneumonia, pulmonary edema, cough, asthma and acute lung injury. This article reviews the correlation and molecular mechanisms between ARDS caused by sepsis, traumatic brain injury and respiratory viruses with TRPV1, aiming to summarize the positive effects of regulating TRPV1 expression on the pathogenesis of ARDS and provide reference for strengthening early diagnosis and effective intervention measures for ARDS.

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Research progress of affective touch intervention on early life stress-related anxiety disorders
LIAO Bingbing, WANG Zhen
2024, 44 (5):  647-652. 
doi: 10.3969/j.issn.1674-8115.2024.05.014

Abstract ( 26 )   HTML ( 6 )   PDF (1215KB) ( 26 )  

Anxiety disorders are characterized by persistent and excessive fear, anxiety and concern, accompanied by avoidance behaviors and physical symptoms such as increased heart rate, shortness of breath and muscle tension, which is one of the most prevalent psychiatric disorders. Research has shown that early life stress (ELS) can increase individual susceptibility to developing anxiety disorders during childhood and adulthood by modifying brain structure and functions. A large number of papers have reviewed the pathophysiological mechanisms of ELS-related anxiety disorders, while only a few have reviewed interventional techniques for ELS-related anxiety disorders. The phenomenon of tactile deprivation is prevalent in individuals experiencing ELS. Most current researches on affective touch and anxiety disorders suggest that affective touch is an intervention for ELS-related anxiety disorders. The review firstly introduces the phenomenon of touch deprivation in individuals experiencing ELS, discusses the effect of affective touch intervention on ELS-related anxiety disorders, and then summarizes the mechanism of affective touch in terms of neural circuits and neuroendocrinology, in order to provide reference for complementary intervention treatment of ELS-related anxiety disorders.

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Functions of SNARE complex in glial cells and its relationship with the development of depressive disorder
GU Juanhua, JIAO Yang, LU Lin, WANG Linlin
2024, 44 (5):  653-657. 
doi: 10.3969/j.issn.1674-8115.2024.05.015

Abstract ( 23 )   HTML ( 9 )   PDF (1174KB) ( 24 )  

Depression is a common cause of human disability and death. Some patients are not sensitive to antidepressants, and also the recurrence rate is very high. Unfortunately, there are many problems with existing antidepressants. So, it is urgent to find a new antidepressant aiming at multiple targets. Recently, researchers have found that soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex is closely related to the progression of depression. This review discusses the potential mechanisms of the SNARE complex in glial cells, and hopes to contribute to the understanding of depression and provide new ideas for clinical development of novel antidepressant drugs.

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Research advances in the electroencephalographic characteristics and treatment of paradoxical insomnia
ZHANG Yu, YUAN Chengmei, XIAO Zeping
2024, 44 (5):  658-662. 
doi: 10.3969/j.issn.1674-8115.2024.05.016

Abstract ( 30 )   HTML ( 7 )   PDF (1227KB) ( 20 )  

Paradoxical insomnia (Para-I), also known as pseudoinsomnia or sleep state misperception, is a condition in which the patient complains of severe insomnia but has no objective evidence of sleep disorder, and daytime functioning may be disrupted disproportionately to the degree of patient-reported sleep loss. Para-I is characterized by overestimation of sleep latency (SL) and underestimation of total sleep time (TST). Incorrect assessment of sleep quality hinders the diagnosis, evaluation of severity, and assessment of clinical efficacy of sleep disorders. The pathogenesis of Para-I remains unclear, but may be related to factors such as depression, anxiety, personality traits, social relationships and specific changes in brain structure and function. Studies on the polysomnography (PSG) of the patients with insomnia have found that changes in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep may be related to the degree of subjective-objective sleep discrepancy. PSG is a valuable diagnostic tool for sleep disorders. It allows for the analysis of sleep structure and related physiological and behavioral changes by monitoring various parameters, including electroencephalogram (EEG), electromyogram (EMG), electrooculogram (EOG), oro-nasal airflow, thoracic and abdominal respiratory motions, oxygen saturation, electrocardiogram (ECG) and snoring. In recent years, studies have increasingly explored the sleep EEG and treatment of Para-I with PSG, resulting in significant progress. This article reviews the latest advances in the electroencephalographic characteristics and treatment of Para-I, providing new ideas for precise treatment.

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